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Clinical Disciplines-ER > Toxidromes > Flashcards

Toxidromes Flashcards

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1
Q

Garlic odor

A
  1. Dimethyl sulfoxide (DMSO) Arsenic

2. Organophosphates

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2
Q

Bitter almonds

A

Cyanide

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3
Q

Rotten eggs

A

Hydrogen sulfide

Sewer Gas

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4
Q

Acetone

A

Isopropyl Alcohol

Ethanol

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5
Q

Shoe polish

A

Nitrobenzene

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6
Q

Peanuts

A

Vacor (rat poison)

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7
Q

Fruity

A

DKA

Isopropanol

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8
Q

Mothballs

A

Naphthalene

If kids eat 2 of these=Hospital

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9
Q

Wintergreen

A

Methylsalicylate

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10
Q

List the causes for a decreased anion gap

A
  1. Lithium
  2. Bromide
  3. Hypoalbuminemia
  4. Multiple Myeloma
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11
Q

Define Kussmaul breathing

A

Acidemia causes Hyperventilation=

Respiratory compensation for metabolic acidosis

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12
Q

What is the normal osmolar gap?

A

< or equal to 10

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13
Q

When is gastric lavage effective?

A

If it’s within 60 minutes of ingestion

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14
Q

Syrup of ipecac effects

A
  • Plant derivative which works centrally and peripherally to induce vomiting
  • Use in remote locations
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15
Q

When is IV lipid emulsion indicated?

A

OD of lipophilic agents (CCB, Beta-Blockers) with cardiac arrest OR
Significant hemodynamic instability failing conventional therapy

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16
Q

Complication of IV lipid emulsion

A

Post-infusion pancreatitis

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17
Q

What are the key sx’s in anticholinergic toxidrome?

A
  1. Dry armpits
  2. Agitated
  3. Hyperthermia
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18
Q

Anticholinergic toxidrome causes

A
  1. Jimson weed
  2. Antihistamines- Benadryl (Diphenhydramine)
  3. Antidepressants, TCAs
  4. Carbamazepine
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19
Q

Anticholinergic toxidrome treatment

A
  1. ABC’s
  2. Supportive care
  3. Rapid cooling- water and fans
  4. Benzodiazepines- Help with agitation
  5. Paralytic Agents- Consider
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20
Q

When should you consider Physostigmine in Anticholinergic toxidrome? Major ADE’s?

A

If have both central and peripheral effects
CI: Heart block, COPD, Bradycardia
ADE: ASYSTOLE

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21
Q

Cholinergic Toxidrome sx’s in muscarinic

A

SLUDGE

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22
Q

Cholinergic Toxidrome sx’s in Nicotinic

A 
Monday – Miosis
Tuesday – Tachycardia
Wednesday – Weakness 
Thursday – Tremors
Friday – Fasciculations 
Saturday – Seizures 
Sunday – Somnolent
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23
Q

Sympathaomimetics Toxidrome sx’s

A 
Anticholinergic sx's:
1. ↑BP and HR
2. Hyperthermia
3. Mydriasis
4. Delusions 
\+ 
5. Seizure
6. Piloerection (hair standing up)
7. Hyperreflexia
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24
Q

Sympathaomimetics Toxidrome causes

A

Stimulants:

  1. Amphetamines
  2. Cocaine
  3. Pseudoephedrine
  4. Caffeine
  5. PCP
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25
Q

Medications that can cause Serotonin Syndrome

A
  1. SSRI
  2. Meperidine (Demerol) + Serotonin enhancing agent
  3. Lithium
  4. Monoamine oxidase inhibition= Rasagilline
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26
Q

What are the triad of sx’s of Serotonin Syndrome?

A
  1. Myoclonus
  2. MS changes
  3. Shivering
    + Agitation
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27
Q

Serotonin Syndrome treatment?

A

Supportive:

  1. Remove offending agent
  2. Reduce temperature
  3. Benzodiazepines
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28
Q

Opiate Toxidrome sx’s

A

Everything decreases!

  1. Pinpoint pupils
  2. Depressed respirations
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29
Q

Opiate Toxidrome treatment

A
  1. ABC’s

2. Naloxone= Narcan

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30
Q

What does a UDS NOT test for?

A
  1. Meperidine
  2. Hydrocodone
  3. Oxycodone
  4. Methadone*
  5. Tramadol
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31
Q

Antidote for Cholinergic toxidrome

A
  1. Atropine

2. Tupam

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32
Q

Sympathomimetics Toxidrome treatment

A
  1. Benzodiazepine
  2. Sodium Bicarb-Correct acidosis
  3. DO NOT give beta blockers
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33
Q

What is the toxic dose of Acetaminophen?

A

140 mg/kg

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34
Q

Toxic effects of acetaminophen toxicity

A
  1. Centrolobular necrosis (liver) = 40%
  2. Renal failure
    3 Vomiting – MCly seen in children
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35
Q

Acetaminophen toxicity antidote

A

N-acetylcysteine (NAC)

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36
Q

Salicyclate Toxicity sx’s

A
  1. Vomting, abd. pain
  2. GI hemorrhage
  3. Hypotension
  4. Increased bleeding time
  5. Agitation, confusion
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37
Q

Salicyclate Toxicity treatment

A
  1. Gastric lavage if within 1 hour of ingestion
  2. Activated charcoal
  3. Sodium Bicarb
  4. Normal saline
38
Q

MCC of seizure in patients with seizure disorder

A
  1. Subtherapeutic level of medication
  2. Infection or hyperthermia
  3. Alcohol use
  4. Head trauma
  5. Breakthrough seizure
39
Q

What anticonvulsant can cause a false positive drug screen for amphetamines?

A

Phenytoin (Dilantin)

40
Q

why can’t you give Phenytoin (Dilantin) IM?

A

Can cause:

  1. Thrombophlebitis
  2. Sterile abscesses
41
Q

Phenytoin (Dilantin) toxicity sx’s

A
  1. Slurred speech
  2. Ataxia
  3. Nystagmus (horizontal)
  4. Visual changes
  5. Decreased LOC
42
Q

Phenytoin (Dilantin) toxicity Tx

A

Supportive

MDAC

43
Q

What is the MCC of coma from overdose?

A

Barbiturates

44
Q

Barbiturates toxicity sx’s

A
  1. CNS depression
  2. Hypothermia
  3. Urinary retention
  4. Hypoglycemia
  5. Decreased motor activity
  6. Aspiration pneumonia
45
Q

Barbiturates toxicity treatment

A
  1. Supportive
  2. Glucose
  3. Narcan
  4. Charcoal
46
Q

Lithium toxicity treatment

A

Benzodiazepines

47
Q

What is the MCly used and abused intoxication in the US?

A

Ethanol

48
Q

List Isopropanol products

A
  1. Rubbing alcohol
  2. Jewelry cleaners
  3. Paint thinners
49
Q

List Methanol products

A
  1. Wood varnishes

2. Windshield washing fluid

50
Q

Metanol toxicity sx’s

A
  1. CNS depression
  2. Vision changes**
  3. Abdominal pain
  4. Hypotension=bad
51
Q

Methanol treatment

A
  1. Supportive
  2. IV fluids
  3. Ethanol
  4. Fomepizole
52
Q

List Ethylene Glycol product

A

Antifreeze

53
Q

What may you see in 50% of cases of Ethylene Glycol toxicity?

A

Calcium oxalate crystalluria

54
Q

Ethylene Glycol toxicity sx’s

A
  1. CNS depression
  2. Tachycardia, tachypnea
  3. Hypertension
  4. Flank pain, renal failure
  5. Hypocalcemia with tetany and QT prolongation
  6. Metabolic Acidosis
55
Q

What is the MC dysrhythmia in calcium channel blockers?

A
  1. AV dissociation
  2. Bradycardia
  3. Increased PR interval
56
Q

Calcium channel blocker treatment

A
  1. CaCl
  2. Insulin + Glucose
  3. Epinephrine
  4. Pacemaker
57
Q

Beta Blocker treatment

A
  1. Glucagon
  2. Epinephrine
  3. Pacemaker
58
Q

Digoxin treatment

A
  1. Vasopressors
  2. Atropine
  3. External pacing
59
Q

TCA treatment

A
  1. Fluids, Bicarb, alpha agonists- Tx hypotension
  2. Benzo + Barbiturates-Tx seizure
  3. Charcoal
60
Q

What other drug combo with TCA will cause death?

A

TCA + Procainamide

61
Q

What is the MCC of unintentional poisoning death in the US?

A

Carbon Monoxide

62
Q

Whipples Triad

A
  1. Hypoglycemia: glucose < 60
  2. Symptoms of hypoglycemia: Diaphoresis, nausea, AMS
  3. Resolution of symptoms with administration of glucose
63
Q

Define Dystonic Reaction

A
  1. Idiosyncratic reaction

2. Sudden onset of abnormal or exaggerated posturing of head, neck, jaw

64
Q

Medications that can cause dystonic reactions

A
  1. Phenothiazines-Phenergan, compazine
  2. Butyrophenones-Haldol
  3. Reglan
65
Q

Risk Factors for development of dystonic reactions

A
  1. Male sex
  2. Young age
  3. Cocaine use
  4. Hypocalcemia
  5. Neurodegenerative disorders
66
Q

Dystonic Reactions clinical presentation

A
  1. Spastic contractures of lips, tongue, face, throat
  2. Trismus, tongue protrusions
  3. Laryngeal and pharyngeal spasms
  4. Fear, anxiety
  5. Oculogyric crisis
67
Q

Dystonic Reaction Tx

A
  1. Benadryl x 3-4 days

2. Benzotropine IV or IM

68
Q

What is the MCC of pediatric mortality secondary to poisoning?

A

Iron poisoning

69
Q

Stage 1 iron poisoning

A

GI injury: 6-12 hrs

  1. V/D, abdominal pain
  2. Hypotension, pallor
  3. Lethargy
  4. Metabolic acidosis
70
Q

Stage 2 iron poisoning

A

6-24 hrs

Hypovolemia

71
Q

Stage 3 iron poisoning

A

Multisystem organ failure

72
Q

Lab findings in iron poisoning

A
  1. Increased WBC- Basophilic stippling

2. Increased glucose

73
Q

Iron poisoning treatment

A
  1. Asx after 6 hrs= Discharge
  2. Whole Bowel irrigation (WBI)
  3. IV Deferoxamine (DFO)
74
Q

What products contain hydrofluoric acid?

A
  1. Glass etching
  2. Metal cleaning
  3. Electronics manufacturing
  4. Rust remover
75
Q

Clinical presentation of hydrofluoric acid toxidrome?

A
  1. Pain out proportion to exam
  2. Hypocalcemia
  3. Hypomagnesemia
76
Q

hydrofluoric acid toxidrome EKG findings

A
  1. Arrhythmias

2. QT prolongation

77
Q

hydrofluoric acid toxidrome CXR findings

A

Pulmonary Edema

78
Q

hydrofluoric acid toxidrome treatment

A
  1. Double gloves for providers
  2. Copious water irrigation
  3. Calcium gluconate
79
Q

What does cocaine show up on a UDS?

A

benzoylecgomine

80
Q

Cocaine toxidrome treatment

A

Benzodiazepines

81
Q

Phenycyclidine (PCP) effects

A
  1. Psychosis: Euphoria, agitation, hallucination, “super human strength”
  2. CV: Tachycardia, HTN
  3. Nystagmus
  4. MIOSIS-Pupul constricted
  5. Salivation
82
Q

Phenycyclidine (PCP) TX

A
  1. IV fluids

2. Benzodiazepines

83
Q

What is the only opiate associated with seizure?

A

Propoxyphene

84
Q

Are the eye constricted or dilated with opiates?

A

Constricted=Miosis

85
Q

Opiate Treatment

A

Narcan

86
Q

MDMA treatment

A

Benzodiazepines

87
Q

What does Amphetamines increase the the activity/release of?

A
  1. Dopamine

2. Norepinephrine

88
Q

Increased dopamine activity results in what effects?

A
  1. Restlessness, hyperactivity
  2. Decreased sleep
  3. Repetitive behavior
89
Q

Increased norepinephrine results in what effects?

A
  1. Mydriasis=Dilation
  2. Bronchodilation
  3. Vasoconstriction
  4. Hypertension
  5. Increased HR
90
Q

Amphetamine treatment

A
  1. Benzodiazepine
  2. Haldol
  3. Cooling

Clinical Disciplines-ER (4 decks)

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